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TABES DORSALIS IN THE NEGRO.
1314 which would be done to nurses of the better class "’y credentials of apparently equal value to imperfectly trained women. Miss Gibson, matron of the Birminghami Infirmary, regarded the suggestion that a new grade off nurses, to be called 11 qualified nurses" and with only one year’s experience, should be instituted as dangerous and1 retrograde in the extreme. She agreed with Dr. Savill as to)
giving
1901 some 863 specimens were reported upon as contrasted with 1700 during an equal period in 1902. The principal work has consisted in the examination of sp"cimens for the bacillus tuberculosis and the bacillus diphtherias and for the In the ca"e of agglutination reaction in enteric fever the use of the direct examinaNeisser’s stain and diphtheria tion of the swab have been so successful that in 50 per cent. of the positive cases it has been possible to send a report within a few hours of the receipt of the specimen, Early diagnosis in diphtheria is of the greatest importance to both patient and practitioner and the laboratory is to be congratulated on this unusually high ratio of t-uccessfal and rapid diagnosis. One of the .most important and striking features of the report is the very complete clinical information of the cases submitted for examination which the director, Dr. P. J. Cammidge, has been able to obtain. This bears witness to the good feeling which exists between the central laboratory and the local medical officers of health and the general practitioners, without which it is impossible to carry on any successful work. It is of vital importance that the results of the laboratory should be correlated with the clinical details if these institutions are to produce really scientific work and to further the progress of preventive
the impossibility of any woman obtaining in a year at aL small workhouse such knowledge as would render her a safe person to be left in charge of patients without supervision. Skilled nursing, she remarked, is a necessity for all who are: sick and she expressed the opinion that it was a gross inj ustice I to the sick poor that so low a standard of knowledge as the) report sanctions should be accepted. Dealing with the) question of the position of superintendent nurses she supported the proposal of the committee to make those officers independent of the matrons and pointed out that any course which tended to reduce the responsibility and the enthusiasm of the Poor-law nurse tended to lessen the supply and to lower the quality of such nurses. Reform, in Miss Gibson’s view, should take the direction of (1) the formation of a special nursing department of the Local Government Board ; and (2) the appointment of women inspectors who were nursing, experts to visit, to inspect, and to report on the nursing of medicine. the small unions. In this way she thought that the debt of gratitude which she described the sick poor as willing to pay TABES DORSALIS IN THE NEGRO. would be largely added to. Several other speakers, including Two grave and incurable diseases of modern life are Mr. J. T. Macnamara, Mrs. Despard, and Mrs. Bedford Fenwick, followed in the same sense and a motion pro- believed by some neurologists to have been acquired by the posed by Dr. Savill was passed unanimously condemning negro with civilisation—viz., general paralysis of the insane the proposals of the Local Government Board and urging and tabes dorsalis. Of tabes in the negro, writes Dr. that their adoption would have a detrimental effect upon d’Orsay Hecht, instructor in neurology in the University nursing generally. It was also decided to ask the Local Medical School, Chicago, in an article published in the Government Board to receive a deputation in connexion with American Journal of the Medical Sciences for October, it has the subject. With the aims of the promoters of the meeting, been possible to obtain very few references in medical in so far as theoe are directed towards maintaining the literature. Von Leyden quotes an apparently well estab.efficiency of nursing in all its branches, we are quite in lished belief among medical men to the effect that "tabes" sympathy. It is eminently desirable that there should be occurs very rarely in the large number of syphilitic npgroes in the United States and in Africa, while the disease is also no ambiguity about the qualifications of nurses and this will certainly arise if the Local Government Board persistsi stated by local physicians to be rare in Cuba. Dr. Potts, in applying the epithet " qualified" to a nurse as an indica- physician to the Dispensary for Nervous Disease in the tion of her having received a minimum of training. University of Pennsylvania, had not seen a single case of tabes dorsalis in the negro in eight years, and Dr. Burr had not seen a single case at the Philadelphia SECOND ANNUAL REPORT OF THE WORK OF Infirmary for Nervous Diseases during 14 years. Dr. Hecht, THE BACTERIOLOGICAL LABORATORY OF having had the opportunity of seeing and studying I If our unTHE WEST RIDING OF YORKSHIRE doubted cases of tabes dorsalis in coloured individnals," three COUNTY COUNCIL. of wh’m were females and one was a male, states that the THE number of county medical officers and of county clinical picture of the disease as exhibited in these cases in public health laboratories will no doubt steadily increase as no way differed from the symptom-complex accustomed to be the public realise the value of the services which are seen among the whites except, perhaps, in the fact that they rendered by them in the preservation of the country from were all d the "amaurotic type"" of the disease. Dr. A. the spread of epidemic disease. Sl1ch annual reports Plehn, who had studied the diseases of the negro in Western as the one under notice will greatly assist this realisaAfrica and who had drawn up an official report on the subject The West Riding County Council having estab- to the German Government in 1895, states that of nervous tion. lished a laboratory offered to undertake free of charge disease he had only seen four caes of epilepsy and an such bacteriological investigations as would be of assist- occasional case of hysteria, which exhausts the list of ance in the diagnosis of certain infectious diseases and neuroses to which the natives are liable. Dr. Hecht thinks of importance to public health. The need of a county that emancipation from slavery has brought to the negro all laboratory has in other cases been met by the utilisation the vices and excesses of western civilisation, that tuberof the fully equipped establishments which were attached culosis, syphilis, and cancer are now deeply rooted affeceither to the provincial universities or other educational tions among them, and that a slight admixture with bodies and thus the services of skilled investigators have the blood of white people has weakened the race. The been secured at a comparatively small expense. There can inter-crossing with new blood has brought with it a be no two opinions as to the legitimacy of the expenditure I, tendency to acquire new diseases. " By an illegitimate of public money for the public health but care should be and universal miscegenation with the whites the typical taken that the resources of the public laboratory are not American negro of to-day has incorporated in his frame the employed for purposes which are but remotely connected deteriorating phenomena of his hybridity." The following is with the public service. The West Riding Laboratory com- one of the four cases recorded by Dr. Hecht. The patient menced work in April, 1901, and a steadily increasing number was a negro woman, aged 39 years, of healthy parentage, in " of cases has been dealt with. In the last nine months of whom there was a slight trace of "white blood. As a ,
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.
.
____
1315 o: two specially equipped "sanitary trains" capable of child she suffered at the age of 12 years from rheumatism or which became chronic owing to hard work and exposure. accommodating a a comparatively insignificant number of At the age of 16 years she gave birth to an illegitimate child, patients the army medical authorities would in the event of p Prior to the birth of her second child at the age of 18 years war v be compelled to depend for the transport by rail of she contracted syphilis from the man who was her husband. sick s and woundfd soldiers upon the ordinary baggage wagon, Her present illness began at the age of 34 years with severe a a species of vehicle which is rendered absolutely unfit recurrent protracted headaches of an agonising character for f the purpose by its lack of suitable springs. So and progressive dimness of vision in the left eye which 1long ago as 1882 Dr. Redard, principal me lical officer of the glasses did not seem to relieve. Eventually she becameState railways in France, drew attention to this subject in a quite blind in the left eye and dim of vision in the right ireport which he addressed to the head of the administration Severe gastric "crises,""girdle sensations"about 1but apparently no action was taken in the matter. Last year eye. l the waist, paræsthesiæ about the feet and ankles, he again returned to the charge. According to an annota"lightning"pains in the legs, and a commencing ataxia Ition in the Archives de Médecine et de Pharmacie Militairea of gait manifested themselves. The sexual desire rapidlytfor August one of the French railway companies has already disappeared and some defect of control of the bladder and constructed 56 third-class carriages with removeable fittings rectum developed. Physical examination showed absence of and containing wide doorways for the admission of litters knee-jerks, optic atrophy with iridoplegia, and exaggeration and we are also told that Dr. Redard has been authorised of the plantar reflexes. The slight ataxia soon disappeared. to inspect the existing rolling stock throughout France with The interval between syphilitic infection and the first a view to the conversion of suitable carriages for ambulance manifestation of tabes was in this case, and in three other purposes. cases, in harmony with what has been observed in white races. "ANTI-VIVISECTIONIST" METHODS IN THE Optic atrophy was present in every one of the four cases and it was singular to note, states Dr. Hecht, that as TEMPLE. the optic atrophy became distinct the further advance of the Now that the Bar has resumed its labours after the long ataxia was checked-a condition to which Benedikt of vacation the attention of the benchers of the Temple may Vienna called attention 16 years ago. Subsequent be called to a large placard which decorates a ground-floor observations by Bonar of New York and Pierre Marie window looking into Elm-court, Temple. It is apparently have emphasised the fact that almost invariably the onset there by someone interested in what is popularly placed of optic atrophy marks the arrest of the ataxic symptoms, a called "anti-vivisection"and consists of a picture of a fact for which an explanation is now found, says Dr. Hecht, in his shirt-sleeves a small dog contemplatirg gentleman in an ingenious theory of " compensation of nerve centres which " before him upon a table. Beside the sits begging and tractsrecently propounded by Edinger. The question dog stands a microscope and a box with articles intended as to why the negroes, amongst whom syphilis is a very to suggest surgical instruments, and under the whole is common disease, should suffer very rarely from tabes is hard inscribed "The Last Appeal," with a reference to the anti"As well might we seek to explain the vivisection"source from which this to answer as yet. entirely absurd adverabsence of tabes in Bosnia and Herzegovina where, as we tisement is taken. The of the picture, of course, suggestion know, the most intense constitutional syphilis is rampant is that the gentleman in his shirt-sleeves is being appealed Dr. Hecht concludes that a con- to for among the natives." mercy by the small dog which he is about to sacrifice stitutional variation has ’been wrought in the American with ruthless cruelty in the supposed interests of science. negro by acclimatisation, by social environment, and more The display is in very bad taste and if the windows of than all else by miscegenation, and from a critical and chambers in the Inns of Court are to be used for purposes of exhaustive study of the facts of his own and other cases he this kind it would be better that the exhibited should posters concludes that the last factor is, above all, essential to theB deal with matters more within the -cope of the lawyer’s production of tabes in a syphilised negro. and not of a cffei-sive to members of be nature calling another learned profession. RAILWAY TRANSPORT FOR SICK AND WOUNDED TUBERCULOSIS OF THE URETHRA. MEN IN TIME OF WAR. .
’
.
-
.
TUBERCULOSIS of the urethra is very rare. The following IN the June issue of Le Caduoée Surgeon-Major Duval c which is recorded by Dr. A. L. UhL.te ixi the Boston of the French army discusses the question of railway case, 1 and Surgical Journal of Oct. 1,,t, m ot great interest. in on Medical for the sick and wounded war While time. transport a tour through British India in 1897-98 he was greatlyA married man, aged 35 years, who had never suffered from impressed by the completeness of the arrangements to thatvenereal di:ea-
giving
1901 some 863 specimens were reported upon as contrasted with 1700 during an equal period in 1902. The principal work has consisted in the examination of sp"cimens for the bacillus tuberculosis and the bacillus diphtherias and for the In the ca"e of agglutination reaction in enteric fever the use of the direct examinaNeisser’s stain and diphtheria tion of the swab have been so successful that in 50 per cent. of the positive cases it has been possible to send a report within a few hours of the receipt of the specimen, Early diagnosis in diphtheria is of the greatest importance to both patient and practitioner and the laboratory is to be congratulated on this unusually high ratio of t-uccessfal and rapid diagnosis. One of the .most important and striking features of the report is the very complete clinical information of the cases submitted for examination which the director, Dr. P. J. Cammidge, has been able to obtain. This bears witness to the good feeling which exists between the central laboratory and the local medical officers of health and the general practitioners, without which it is impossible to carry on any successful work. It is of vital importance that the results of the laboratory should be correlated with the clinical details if these institutions are to produce really scientific work and to further the progress of preventive
the impossibility of any woman obtaining in a year at aL small workhouse such knowledge as would render her a safe person to be left in charge of patients without supervision. Skilled nursing, she remarked, is a necessity for all who are: sick and she expressed the opinion that it was a gross inj ustice I to the sick poor that so low a standard of knowledge as the) report sanctions should be accepted. Dealing with the) question of the position of superintendent nurses she supported the proposal of the committee to make those officers independent of the matrons and pointed out that any course which tended to reduce the responsibility and the enthusiasm of the Poor-law nurse tended to lessen the supply and to lower the quality of such nurses. Reform, in Miss Gibson’s view, should take the direction of (1) the formation of a special nursing department of the Local Government Board ; and (2) the appointment of women inspectors who were nursing, experts to visit, to inspect, and to report on the nursing of medicine. the small unions. In this way she thought that the debt of gratitude which she described the sick poor as willing to pay TABES DORSALIS IN THE NEGRO. would be largely added to. Several other speakers, including Two grave and incurable diseases of modern life are Mr. J. T. Macnamara, Mrs. Despard, and Mrs. Bedford Fenwick, followed in the same sense and a motion pro- believed by some neurologists to have been acquired by the posed by Dr. Savill was passed unanimously condemning negro with civilisation—viz., general paralysis of the insane the proposals of the Local Government Board and urging and tabes dorsalis. Of tabes in the negro, writes Dr. that their adoption would have a detrimental effect upon d’Orsay Hecht, instructor in neurology in the University nursing generally. It was also decided to ask the Local Medical School, Chicago, in an article published in the Government Board to receive a deputation in connexion with American Journal of the Medical Sciences for October, it has the subject. With the aims of the promoters of the meeting, been possible to obtain very few references in medical in so far as theoe are directed towards maintaining the literature. Von Leyden quotes an apparently well estab.efficiency of nursing in all its branches, we are quite in lished belief among medical men to the effect that "tabes" sympathy. It is eminently desirable that there should be occurs very rarely in the large number of syphilitic npgroes in the United States and in Africa, while the disease is also no ambiguity about the qualifications of nurses and this will certainly arise if the Local Government Board persistsi stated by local physicians to be rare in Cuba. Dr. Potts, in applying the epithet " qualified" to a nurse as an indica- physician to the Dispensary for Nervous Disease in the tion of her having received a minimum of training. University of Pennsylvania, had not seen a single case of tabes dorsalis in the negro in eight years, and Dr. Burr had not seen a single case at the Philadelphia SECOND ANNUAL REPORT OF THE WORK OF Infirmary for Nervous Diseases during 14 years. Dr. Hecht, THE BACTERIOLOGICAL LABORATORY OF having had the opportunity of seeing and studying I If our unTHE WEST RIDING OF YORKSHIRE doubted cases of tabes dorsalis in coloured individnals," three COUNTY COUNCIL. of wh’m were females and one was a male, states that the THE number of county medical officers and of county clinical picture of the disease as exhibited in these cases in public health laboratories will no doubt steadily increase as no way differed from the symptom-complex accustomed to be the public realise the value of the services which are seen among the whites except, perhaps, in the fact that they rendered by them in the preservation of the country from were all d the "amaurotic type"" of the disease. Dr. A. the spread of epidemic disease. Sl1ch annual reports Plehn, who had studied the diseases of the negro in Western as the one under notice will greatly assist this realisaAfrica and who had drawn up an official report on the subject The West Riding County Council having estab- to the German Government in 1895, states that of nervous tion. lished a laboratory offered to undertake free of charge disease he had only seen four caes of epilepsy and an such bacteriological investigations as would be of assist- occasional case of hysteria, which exhausts the list of ance in the diagnosis of certain infectious diseases and neuroses to which the natives are liable. Dr. Hecht thinks of importance to public health. The need of a county that emancipation from slavery has brought to the negro all laboratory has in other cases been met by the utilisation the vices and excesses of western civilisation, that tuberof the fully equipped establishments which were attached culosis, syphilis, and cancer are now deeply rooted affeceither to the provincial universities or other educational tions among them, and that a slight admixture with bodies and thus the services of skilled investigators have the blood of white people has weakened the race. The been secured at a comparatively small expense. There can inter-crossing with new blood has brought with it a be no two opinions as to the legitimacy of the expenditure I, tendency to acquire new diseases. " By an illegitimate of public money for the public health but care should be and universal miscegenation with the whites the typical taken that the resources of the public laboratory are not American negro of to-day has incorporated in his frame the employed for purposes which are but remotely connected deteriorating phenomena of his hybridity." The following is with the public service. The West Riding Laboratory com- one of the four cases recorded by Dr. Hecht. The patient menced work in April, 1901, and a steadily increasing number was a negro woman, aged 39 years, of healthy parentage, in " of cases has been dealt with. In the last nine months of whom there was a slight trace of "white blood. As a ,
-
.
.
____
1315 o: two specially equipped "sanitary trains" capable of child she suffered at the age of 12 years from rheumatism or which became chronic owing to hard work and exposure. accommodating a a comparatively insignificant number of At the age of 16 years she gave birth to an illegitimate child, patients the army medical authorities would in the event of p Prior to the birth of her second child at the age of 18 years war v be compelled to depend for the transport by rail of she contracted syphilis from the man who was her husband. sick s and woundfd soldiers upon the ordinary baggage wagon, Her present illness began at the age of 34 years with severe a a species of vehicle which is rendered absolutely unfit recurrent protracted headaches of an agonising character for f the purpose by its lack of suitable springs. So and progressive dimness of vision in the left eye which 1long ago as 1882 Dr. Redard, principal me lical officer of the glasses did not seem to relieve. Eventually she becameState railways in France, drew attention to this subject in a quite blind in the left eye and dim of vision in the right ireport which he addressed to the head of the administration Severe gastric "crises,""girdle sensations"about 1but apparently no action was taken in the matter. Last year eye. l the waist, paræsthesiæ about the feet and ankles, he again returned to the charge. According to an annota"lightning"pains in the legs, and a commencing ataxia Ition in the Archives de Médecine et de Pharmacie Militairea of gait manifested themselves. The sexual desire rapidlytfor August one of the French railway companies has already disappeared and some defect of control of the bladder and constructed 56 third-class carriages with removeable fittings rectum developed. Physical examination showed absence of and containing wide doorways for the admission of litters knee-jerks, optic atrophy with iridoplegia, and exaggeration and we are also told that Dr. Redard has been authorised of the plantar reflexes. The slight ataxia soon disappeared. to inspect the existing rolling stock throughout France with The interval between syphilitic infection and the first a view to the conversion of suitable carriages for ambulance manifestation of tabes was in this case, and in three other purposes. cases, in harmony with what has been observed in white races. "ANTI-VIVISECTIONIST" METHODS IN THE Optic atrophy was present in every one of the four cases and it was singular to note, states Dr. Hecht, that as TEMPLE. the optic atrophy became distinct the further advance of the Now that the Bar has resumed its labours after the long ataxia was checked-a condition to which Benedikt of vacation the attention of the benchers of the Temple may Vienna called attention 16 years ago. Subsequent be called to a large placard which decorates a ground-floor observations by Bonar of New York and Pierre Marie window looking into Elm-court, Temple. It is apparently have emphasised the fact that almost invariably the onset there by someone interested in what is popularly placed of optic atrophy marks the arrest of the ataxic symptoms, a called "anti-vivisection"and consists of a picture of a fact for which an explanation is now found, says Dr. Hecht, in his shirt-sleeves a small dog contemplatirg gentleman in an ingenious theory of " compensation of nerve centres which " before him upon a table. Beside the sits begging and tractsrecently propounded by Edinger. The question dog stands a microscope and a box with articles intended as to why the negroes, amongst whom syphilis is a very to suggest surgical instruments, and under the whole is common disease, should suffer very rarely from tabes is hard inscribed "The Last Appeal," with a reference to the anti"As well might we seek to explain the vivisection"source from which this to answer as yet. entirely absurd adverabsence of tabes in Bosnia and Herzegovina where, as we tisement is taken. The of the picture, of course, suggestion know, the most intense constitutional syphilis is rampant is that the gentleman in his shirt-sleeves is being appealed Dr. Hecht concludes that a con- to for among the natives." mercy by the small dog which he is about to sacrifice stitutional variation has ’been wrought in the American with ruthless cruelty in the supposed interests of science. negro by acclimatisation, by social environment, and more The display is in very bad taste and if the windows of than all else by miscegenation, and from a critical and chambers in the Inns of Court are to be used for purposes of exhaustive study of the facts of his own and other cases he this kind it would be better that the exhibited should posters concludes that the last factor is, above all, essential to theB deal with matters more within the -cope of the lawyer’s production of tabes in a syphilised negro. and not of a cffei-sive to members of be nature calling another learned profession. RAILWAY TRANSPORT FOR SICK AND WOUNDED TUBERCULOSIS OF THE URETHRA. MEN IN TIME OF WAR. .
’
.
-
.
TUBERCULOSIS of the urethra is very rare. The following IN the June issue of Le Caduoée Surgeon-Major Duval c which is recorded by Dr. A. L. UhL.te ixi the Boston of the French army discusses the question of railway case, 1 and Surgical Journal of Oct. 1,,t, m ot great interest. in on Medical for the sick and wounded war While time. transport a tour through British India in 1897-98 he was greatlyA married man, aged 35 years, who had never suffered from impressed by the completeness of the arrangements to thatvenereal di:ea-